Claim CLM-2024-001007

Claim CLM-2024-001007
2/60

Key Facts

LOB:HOME
Loss Type:Subsidence
Outcome:Cash Settlement
Amount:GBP 34,016
Risk Score:51 (medium)
Date of Loss:2024-10-08
Settlement:GBP 34,016

Timeline

2024-10-08Incident occurred
2024-10-09Claim reported
2024-10-15Assessment completed
2024-11-17Decision made
2024-11-22Claim closed

Analysis

NEEDS REVIEW
4 FAIL4 WARN22 PASS
FAILS1Exclusion Invoked Without Evidence Pack
FAILS2Gradual Damage Decisions Supported by Proof
FAILS2No-Update Gaps (Silence Periods)

Inspections

30 inspections
Summary
CoverageExclusion Invoked Without Evidence PackFAILS182%No expert report supports3
InvestGradual Damage Decisions Supported by ProofFAILS279%Gradual damage claimed without proof3
CommsNo-Update Gaps (Silence Periods)FAILS285%Customer left waiting3
FinanceReserve/Exposure Structure PresentFAILS288%Missing exposure lines2
CoverageSettlement Method Consistent with IndemnityWARNS272%Settlement rationale brief1
InvestInvestigation Thoroughness RecordedWARNS286%Investigation documented but brief1
AltAccAA Timeline Aligns with Repair TimelineWARNS274%Needs attention2
FinanceDuplicate Payments / Near-DuplicatesWARNS188%Needs attention2
FileRequired Evidence Present (by Peril/Archetype)PASSS287%Evidence pack complete1
FileDocument Quality / OCR RiskPASSS389%Documents are text-extractable2
FileClaim Timeline CoherencePASSS288%Timeline events are coherent1
FileStructured vs Narrative Mismatch (Loss Type/Cause/Pathway)PASSS272%No field/notes conflict1
FileContents Itemisation CompletenessPASSS294%All items captured1
CoverageSubsidence/Ground Movement Classification SupportedPASSS193%Technical evidence present2
InvestSubsidence Expert Evidence + Monitoring PresentPASSS193%Monitoring data present2
InvestMajor Water Damage: Source and Mitigation EvidencePASSS272%Leak source identified1
CommsFirst Contact TimelinessPASSS283%Timely customer engagement1
CommsDecline/Partial Settlement Explanation QualityPASSS276%Policy terms linked to outcome1
RepairRepair Route Scope/Completion EvidencePASSS276%Scope and completion documented1
RepairRepair Quality Risk (Rework Loop)PASSS276%Single repair cycle2
RepairRepairs Must Be Effective and LastingPASSS187%Repairs effective and lasting1
CashCash Settlement Offered with Documented RationalePASSS283%Choice justified2
CashCash Settlement Oversight & Monitoring PresentPASSS292%Monitoring active1
CashVulnerability ConsideredPASSS289%Vulnerability considered1
AltAccAA Need Assessed and DocumentedPASSS286%Habitability checked1
FinanceLarge Reserves/Payments Have Approval TrailPASSS290%Large payments have approval trail1
FinancePayment Without Supporting DocumentPASSS287%Invoices linked1
FinanceClosed Claim with Open Reserves / Open TasksPASSS271%Clean closure2
RecoveryRecovery Reserve Exists but No Action EvidencePASSS295%Progress evidenced1
RecoveryRecovery Received Without Matching ExpectationPASSS289%Recovery reconciled1
Evidence

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